Home » Health » Medicine

How Dangerous Are COX-2 Drugs For Arthritis?

Oct 28, 2007
Ever since the voluntary withdrawal of rofecoxib (Vioxx) from the market, debate has raged regarding the risks of COX-2 drugs. Another casualty of the COX-2 "wars" was valdecoxib (Bextra), for an unrelated reason (rashes).

The debate has been fueled, in part, by hysteria, rather than data. What do we know about COX-2 drugs right now? For one, we know that they cause many fewer severe side effects in the gastrointestinal tract than traditional non-steroidal anti-inflammatory drugs (NSAIDS).

Also, investigations regarding specific damage to the small bowel show that COX-2 drugs cause less damage in this location than NSAIDS combined with proton-pump inhibitors (drugs like Nexium, Protonix, Prilosec, etc.) As a result, it is recommended that in patients requiring an anti-inflammatory drug, that COX-2 preparations are preferred for patients with gastrointestinal risk factors such as a prior history of ulcers or who are taking medicines such as anticoagulants (Coumadin) or corticosteroids.

Two other advantages of COX-2 drugs are that they cause much less bleeding than standard NSAIDS because they do not affect platelet function and that they can be used in patients who have aspirin-induced asthma.

An increase in cardiovascular events in patients taking COX-2 drugs was first noted during studies assessing the effect of COX-2 drugs in patients with adenomas of the colon.

Other studies then showed that regular tradtitional NSAIDS such as diclofenac (Voltaren) result in a similar cardiovascular risk. Further research has shown that all NSAIDS have this increase in cardiovascular risk that is indistinguishable from that associated with COX-2 drugs. This indicates that there is, at present, no distinction as far as cardiovascular risk associated with COX-2 drugs versus standard NSAIDS.

Another interesting twist is that standard non-NSAID analgesics such as acetaminophen (Tylenol) also inhibit COX-2 in vivo and should be evaluated for cardiovascular risk.

A recent analysis of the Nurses' Health Studies showed that volunteers taking acetaminophen at daily doses of more than 500 mg had a significantly higher risk of developing hypertension in comparison with a group not taking acetaminophen. The relative risk of hypertension associated with acetaminophen was surprisingly similar to that of NSAIDS. Confirming this finding, a large, prospective study showed that use of more than 15 tablets of acetaminophen per week leads to about the same risk as NSAIDS for cardiovascular events.

Current practice is to advise that patients take the lowest dose of COX2 inhibitor for as brief as time as possible. Exactly what the "safest" dose is and what the "safest length of time" is, still are unclear.

Additional studies are being performed that hopefully will identify and characterize laboratory markers that could be utilized to identify patients at cardiovascular risk before a decision is taken concerning the use of NSAIDS and COX2 inhibitors, in particular.

What's the take home message here? The first is that both traditional NSAIDS as well as COX-2 inhibitors carry the same risk for cardiovascular risks. In patients with gastrointestinal risk factors who require anti-inflammatory drugs, COX-2 preparations may be preferred over a combination of traditional NSAIDS and proton pump inhibitors. Data regarding this recommendation are still not set in concrete.

Analgesics such as acetaminophen may not be as safe as once supposed.

The "safest" dosing regimen for COX-2 drug administration remains to be defined. Further research is required to develop safer and more effective medicines.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
Please Rate:
(Average: Not rated)
Views: 127
Print Email Share
Article Categories
    • Artists
    • Gambling
    • Humanities
    • Humor
    • Movies
    • Music
    • Photography
    • Tattoos
    • Television
    • Classic Cars
    • Motorcycles
    • Recreational Vehicles
    • SUVs
    • Trucks
    • Vans
    • Branding
    • Business Opportunities
    • Careers and Jobs
    • Corporate
    • Customer Service
    • Direct Mail
    • Entrepreneurship
    • Ethics
    • Financing
    • Franchising
    • Home-Based Business
    • Human Resources
    • Import and Export
    • Leadership
    • Management
    • Market Research
    • Marketing and Advertising
    • Negotiation
    • Network Marketing
    • Networking
    • Organizational
    • Presentation
    • Project Management
    • Public Relations
    • Small Business
    • Strategic Planning
    • Team Building
    • Telemarketing
    • Training
    • Data Recovery
    • Databases
    • Games
    • Hardware
    • Networks
    • Operating Systems
    • Programming
    • Security
    • Software
    • Spyware and Viruses
    • Ask an Expert
    • College and University
    • Home Schooling
    • K-12
    • Languages
    • Online Education
    • Psychology
    • Accounting
    • Credit
    • Currency Trading
    • Debt Consolidation
    • Insurance
    • Investing
    • Leasing
    • Loans
    • Mortgage
    • Mutual Funds
    • Personal Finance
    • Stock Market
    • Structured Settlements
    • Taxes
    • Wealth Building
    • Coffee
    • Cooking
    • Gourmet
    • Recipes
    • Wine and Spirits
    • Arts and Crafts
    • Babies
    • Collecting
    • Elderly Care
    • Genealogy
    • Hobbies
    • Parenting
    • Pets
    • Pregnancy
    • Woodworking
    • Feng Shui
    • Gardening
    • Home Appliances
    • Home Security
    • Interior Design
    • Landscaping
    • Affiliate Programs
    • Article Marketing
    • Auctions
    • Audio
    • Banner Advertising
    • Blogging
    • Broadband
    • Domain Names
    • E-Books
    • E-Commerce
    • Email Marketing
    • Ezines and Newsletters
    • Forums
    • Internet Marketing
    • Link Popularity
    • Pay-Per-Click
    • Podcasting
    • RSS
    • Search Engine Marketing
    • Search Engine Optimization
    • Security
    • Social Media
    • Spam
    • Video
    • Viral Marketing
    • Web Design
    • Web Development
    • Web Hosting
    • Copyright
    • Cyber Law
    • Intellectual Property
    • National, State, Local
    • Patents
    • Regulatory Compliance
    • Trademarks
    • Buying
    • Selling
    • Baseball
    • Basketball
    • Boating
    • Cycling
    • Extreme Sports
    • Fishing
    • Football
    • Golf
    • Hockey
    • Hunting
    • Martial Arts
    • Running
    • Scuba Diving
    • Soccer
    • Swimming
    • Tennis
    • Dating
    • Divorce
    • Marriage
    • Weddings
    • Astrology
    • Buddhism
    • Christianity
    • Faith
    • Hinduism
    • Islam
    • Judaism
    • Meditation
    • Metaphysical
    • New Age
    • Cable and Satellite TV
    • Cell Phones
    • Communication
    • Gadgets and Gizmos
    • GPS
    • Satellite Radio
    • Video Conferencing
    • VoIP
    • Addictions
    • Coaching
    • Goal Setting
    • Motivational
    • Stress Management
    • Time Management
    • Clothing
    • Electronics
    • Fashion
    • Gifts
    • Jewelry
    • Causes and Organizations
    • Environment
    • History
    • Holidays
    • Men's Issues
    • Nature
    • Philosophy
    • Politics
    • Women's Issues
    • World Affairs
    • Air Travel
    • Camping
    • Cruises
    • Destinations
    • Outdoors
    • Article Writing
    • Book Reviews
    • Copywriting
    • Fiction
    • Non-Fiction
    • Poetry
    • Quotes
    • Screenplay
    • Tools and Resources